Provider Demographics
NPI:1659829307
Name:KENNEDY, DINA
Entity Type:Individual
Prefix:
First Name:DINA
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DINA
Other - Middle Name:ANNE
Other - Last Name:BAURKOT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS-CCC-SLP
Mailing Address - Street 1:1562 DUXBURY CT
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-1943
Mailing Address - Country:US
Mailing Address - Phone:201-638-1321
Mailing Address - Fax:
Practice Address - Street 1:1562 DUXBURY CT
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-1943
Practice Address - Country:US
Practice Address - Phone:201-638-1321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-12
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL008886235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA235200000XOtherTAXONOMY
PASL008886OtherSLP LICENSE